Several activities are included in this program. One activity involves a collaboration with the Diabetes Center of Excellence (DCOE) at Phoenix Indian Medical Center (PIMC). We collected and analyzed data from a quality improvement project in which nurse case managers were empowered to adjust antihyperglycemic medications in patients with diabetes to more rapidly optimize glycemic control in a system that does not have sufficient capacity for primary care providers to meet its patient care needs. A manuscript regarding this aspect of the project has been published. We have also collaborated with PIMC to develop a protocol for a pilot study of an intensive lifestyle intervention to optimize weight gain and glycemia in pregnancy. We have submitted this protocol for scientific review, and we plan to begin collecting data under this protocol during FY 2012. We have begun a project with the Phoenix Indian Medical Center and Joslin Vision Network to determine factors responsible for successful implementation of a telemedicine program to identify patients with diabetic retinopathy within the Indian Health Service. We have analyzed data regarding trends in medication use in a population with a high prevalence of type 2 diabetes. A manuscript that includes this analysis was published in fall 2010.